5 Million New Yorkers Just Got Better Health Care

5 Million New Yorkers Just Got Better Health Care

Good morning. There are people who actually want root canals. We’ll look at a change in state rules that means they can now get them.

Still, there were gaps. Medicaid considers dentistry an optional category, but under federal law, if a state provides any coverage in an optional category, it has to provide coverage for all medically necessary procedures in that category.

The Legal Aid Society, which filed the suit that led to this settlement, argued that New York routinely denied coverage of medically necessary dental work. New York limited its Medicaid dental coverage for the same reason other states do: to save money.

A lawyer from the Legal Aid Society told you that New York’s rules were “structured to pull your teeth rather than save them.” If that’s so, can’t pulling one tooth endanger others?

Under the old Medicaid rules in New York, as long as you had four matched upper-and-lower pairs of back teeth, that was considered adequate. So you could end up losing up to eight of your back teeth (in addition to your four wisdom teeth) before Medicaid would start covering procedures to save the remaining ones.

One problem with this approach is that once a tooth’s neighbor is removed, the tooth can start to move and drift, and then the problems multiply.

Will this begin to close racial disparities for some people?

Racial disparities in access to health care are one of the main drivers in the difference in health outcomes and in shorter life expectancy for some ethnic groups, particularly Black people. Dental care is no different from other categories of health care in this regard. The Centers for Disease Control and Prevention found that Black and brown adults suffer from untreated dental disease at nearly twice the rate as white adults.

People from ethnic minorities are more likely to be poor, and poor people are more likely to have had inadequate dental care their whole lives, so that later in life they are more likely to develop the kinds of problems that New York did not cover in the past but will from now on. These changes could help close the gap.

Put the changes in personal terms. What will they mean to someone with dental problems that Medicaid had refused to pay for in the past?

One plaintiff in the class action suit has lived with a horrible dental situation for years. His name is Matt Adinolfi. He’s a former New York City cabby who’s now retired and lives upstate. Around 2010, he developed an infection that spread throughout his mouth.

He told me that root canals probably would have saved his teeth, “but I didn’t have that kind of money.” Doctors told him the infection was in danger of spreading to his organs. “At that point, it was either pull the teeth out or die,” he said. So he had all his teeth extracted except for three bottom front teeth, which by themselves don’t do you a whole lot of good.

Then one thing led to another. He got dentures through Medicaid, but they never fit right. They would fall out of place if he ate with them. He ended up with a denture cemented to his remaining teeth on the bottom, but for his upper mouth, he needed implants to hold the denture in place, and Medicaid wouldn’t cover them. So he would take his upper denture out to eat, which meant his upper gums were banging on his lower denture, and he developed gum problems.

And then there’s the social aspect. Apart from all the pain and discomfort, he found it impossible to get into a romantic relationship because he would have to take out his floppy top denture before he would kiss someone, “and then you can notice how sucked-in my face is.” He went 10 years without a girlfriend because he couldn’t handle the embarrassment.

Adinolfi’s story really hit home for me. I’ve had many root canals that were all covered by private insurance. Now Medicaid will cover Adinolfi’s implants.


Prepare for more of the same. It’s going to be breezy with showers, and maybe thunder and hail. The temperature will be in the mid- to high 50s. Tonight, under mostly cloudy skies, temperatures will remain below average for early May — only in the mid-40s.


In effect until May 18 (Solemnity of the Ascension).

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